Rural clinics work to end doctor shortages

SEATTLE -- Hospitals and clinics in central Washington are trying to get out in front of expected doctor shortages when the national health care overhaul takes full effect next year.Washington officials expect more than 325,000 state residents to become eligible for health insurance after an expected expansion of Medicaid eligibility in the state. Thousands more are expected to buy health insurance through the state's new health insurance exchange, which opens in October.The expected influx of new patients will likely put even more pressure on communities that don't have enough doctors.Washington ranks 13th nationally in total active primary care physicians per 100,000, with 5,971 doctors to serve more than 6.7 million people as of 2010, according to American Medical Association data. These doctors are not distributed evenly across the state, with rural areas experiencing the most severe shortages.To attract more doctors to rural parts of the state, medical organizations are training future physicians where they are most needed instead of in big cities where most doctors do their practical internships.On Monday, the Yakima Valley Farm Workers Clinic opens a new, three-year osteopathic residency program in Prosser, to train doctors who share their commitment to rural health care. Both of the group's first two interns also have personal connections to central Washington.One studied osteopathic medicine at Pacific Northwest University in Yakima and grew up in eastern Washington. The other has extended family in central Washington and grew up in rural Nevada."There already is a primary care physician shortage, especially here in the lower Yakima Valley," said Dr. Katheryn Norris, director of the new training program. Osteopathic doctors take an alternative approach to medical care, but still accept insurance, prescribe drugs, do surgery and work in hospitals and clinics.She hopes this program and another internship program for MDs at nearby Central Washington Family Medicine will help alleviate some of the pressure of the expected influx of new patients.According to statistics from the U.S. Department of Health and Human Services, Yakima County is one of the places in Washington state already experiencing a doctor shortage. Other locations with spotty coverage include parts of Chelan, Douglas, Ferry, Grant, Grays Harbor, Okanogan, Pend Oreille, San Juan and Wahkiakum counties, as well as tribal health centers across the state.About 1 million Washington residents are uninsured, or about 1 in 7 people who live in the state. Officials do not know the total number who will benefit from an expansion in Medicaid coverage or will buy health insurance through the exchange.The University of Washington Medical Center, which trains doctors for Washington, Wyoming, Alaska, Montana and Idaho, has focused on rural health care for decades. Students in the program do some of their learning and practical work in small towns in the five-state region.Dr. Roger Rosenblatt, vice chairman of the UW Department of Family Medicine, said the Affordable Care Act is going to increase the demand for family practice doctors in rural areas, where local communities are already finding it difficult to recruit new physicians to replace an aging cadre of doctors."The issue is the pipeline for producing them is seven years," he said.UW offers several special pathways to encourage students to focus their studies -- and hopefully their medical practice -- on underserved groups, including American Indian and Hispanic populations.A program called TRUST for Targeted Rural Underserved Track gets medical students working in a rural clinic before they step into their first medical school classroom, and they continue to work in those clinics through their four years of study.Medical student Megan Penna, who grew up in rural Oregon, was attracted to the TRUST program because she hopes to practice rural medicine when she completes her education.She has been working in two small clinics in Lynden and Birch Bay, in Washington's northwest corner, including four weeks this summer after completing her first year of medical school."I really like the breadth of family medicine," she said, adding, "I'm definitely attracted to rural communities. I see myself ending up somewhere similar."Although all medical students get plenty of practical experience during their education, Penna said the TRUST program is special because all her clinical work will be done with the same two doctor-mentors, until she starts interning in her fifth year.She began by shadowing the doctors and has moved up to interviewing patients and doing some of the physical exam. Her mentors ask her questions and test her knowledge and invite her to make a preliminary diagnosis."It's so much fun. I actually love it," said Penna, 23, who began her college studies as an economics major, then moved into scientific research and found her place in medicine after her first related undergraduate course.Medical students talk about doctor shortages and the effect of the Affordable Care Act, Penna said. She has noticed that most of the practicing doctors she has met will be retiring in the next 10 to 15 years, including her two mentors."I'm curious to see what will happen with the Affordable Care Act," she said.

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